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t <br /> �r- Ontario Ministry of Municipal Affairs Financial Statement - Auditor's Report <br /> and Housing <br /> Form 4 <br /> Municipal Elections Act, 1996(Section 78) <br /> Instructions: <br /> All candidates must complete Boxes A and B. Candidates who receive contributions or incur expenses beyond the nomination fee <br /> must complete Boxes C, D, Schedule 1, and Schedule 2 as appropriate. Candidates who receive contributions or incur expenses in <br /> excess of$10,000 must also attach an Auditor's Report. <br /> All surplus funds(after any refund to the candidate or his or her spouse)shall be paid immediately over to the clerk who was responsible <br /> for the conduct of the election. <br /> YYYY MM DD YYYY MM DD <br /> For the campaign period from(day candidate filed nomination) 1 10)4 log loct to a014 I 1 I0(o <br /> Primary filing reflecting finances to December 31 (or 45th day after voting day in a by-election) <br /> ❑ Supplementary filing including finances after December 31 (or 45th day after voting day in a by-election) <br /> Box A: Name of Candidate and Office <br /> Candidate's name as shown on the ballot <br /> ----__.._ <br /> Last Name Given Name(s) <br /> Ande.4-5cr r,% -T q i, <br /> Name of office for which the candidate sought election Ward name or no. (if any) <br /> CGuC-) C i I io r <br /> Name of Municipality <br /> rOWi1 <br /> Spending limit Issued by clerk <br /> $ 17, 3a1. �b <br /> [rl did not accept any contributions or incur any expenses other than the nomination fee. (Complete Box A and B only) <br /> Box B: Declaration <br /> T<:% 'tcjlrs l,_l a candidate in the municipality of <br /> k na 5Vi I le hereby declare that to the best of my knowledge and belief that these <br /> financial statements and attached supporting schedules are true and correct. <br /> Declared before(clerk or commissioner) <br /> in the -row n of CCU 11 dF� ' <br /> Y <br /> on(yyyy/mm/dd) J LP <br /> Signature of Clerk or Commissioner Signature of Candidate <br /> S Est-vkC.ES <br /> Date Filed in the Clerk's Office(yyyy/mm/dd) <br /> 9503P(2013/11) a Queen's Printer for Ontario,2013 Disponible an frangais Page 1 of 8 <br />
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